Opinion

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When a doctor asks for help

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Recent media reports of young doctors who have tragically died by suicide have again highlighted our vital role as treating GPs when colleagues present with distress or mental illness.
 
As GPs, we are often the first, and sometimes the only, trusted point of contact for a doctor in crisis.
 
Burnout or work-related mental injury?
The so-called epidemic of ‘burnout’ across the medical profession is, in many cases, not burnout at all – it is a work-related mental injury arising from exposure to unsafe workloads, moral injury, bullying or trauma within health systems that are no longer viable.
 
Recognising this difference changes everything about how we assess, treat, and support our colleagues.
 
The ICD-11 defines burnout as ‘a syndrome resulting from chronic workplace stress that has not been successfully managed, characterised by exhaustion, cynicism and reduced professional efficacy’.
 
By contrast, a work-related mental injury describes clinically significant psychological dysfunction caused or worsened by work exposures – including repeated traumatic events, chronic workload pressure, or workplace conflict.
 
For doctors with mental injury, generic self-care and brief interventions, or a few employee assistance program (EAP) telephone calls, are rarely enough.
 
Trauma, PTSD, and complex PTSD
Doctors are routinely directly or indirectly exposed to traumatic clinical events and often overlook the cumulative negative impact because ‘it’s part of the job’.
 
Self-diagnosis is to be avoided but it can be helpful to be reminded of the definitions of post-traumatic stress disorder (PTSD) or complex PTSD (CPTSD) because they can be misdiagnosed as anxiety, depression or ‘burnout’.
 
According to the ICD-11:

• PTSD arises after exposure to a threatening or horrific event such as suicide, with re-experiencing, avoidance, negative mood and hyperarousal
• CPTSD includes these symptoms plus pervasive problems in emotional regulation, self-worth and relationships, following prolonged or repeated trauma such as bullying, harassment or chronic overwork

These injuries require comprehensive mental health assessment, evidence-based psychological therapy, pharmacological support when indicated, and long-term relapse prevention, combined with work health and safety interventions.
 
Of course, this can be hugely challenging in resource constrained  GP consultations in the context of a shortage of psychologists and psychiatrists to meet all patients’ needs in the context of a national mental health crisis.
 
Trauma-informed care is important. The RACGP provides many resources to assist GPs care for other doctors and themselves. It may be helpful for GPs to draw on other specialised services such as Phoenix Australia or the Blue Knot Foundation for guidance.
 
Mandatory reporting: Clarifying the myths
It is the fear of mandatory reporting which remains the major barrier to doctors seeking help.
 
It’s time to clear up the myths because the law is clear:
 

• A treating practitioner must report only if a doctor’s impairment poses a substantial risk of harm to patients
• If the doctor is under active treatment and monitoring or takes time off to recover with a confidential medical certificate, mandatory reporting does not apply

Despite this, there is evidence of over-reporting by colleagues unfamiliar with the threshold. This misinformation fuels stigma and prevents early help-seeking.
 
Every GP can  confidently reassure colleagues that engaging in treatment protects both patients and practitioners.
 
The GP’s clinical role
Early intervention prevents crisis.
 
Colleagues can be encouraged to establish a therapeutic relationship with an independent GP, not a friend or practice partner, and to attend routine preventive health care including mental health screening proactively rather than reactively.
 
When a colleague seeks assistance, it can be helpful to:
 
Assess comprehensively

• Explore workplace hazards, bullying, excessive workloads and recent clinical or medico-legal stressors
• Screen for PTSD, CPTSD, depression, anxiety, and substance use
• Consider trauma history and moral injury, not just stress or fatigue

Treat holistically

• Provide or refer for evidence-based psychological therapy and/or pharmacotherapy as indicated
• Plan longer consultations and structured follow-up for relapse prevention
• Collaborate with psychologists, psychiatrists, and workplace Work Health and Safety (WHS) advisers where appropriate

Address the workplace context
Under Australia’s WHS law, psychological hazards are now formally recognised as important as physical hazards.
 
Employers, including health services, have a legal duty to eliminate or minimise psychosocial risks such as excessive workload, bullying or violence.
 
Where a doctor’s condition is aggravated by unsafe work systems, GPs can recommend temporary adjustments, lighter duties, or a staged return-to-work plan. For more information refer to the SafeDr website.
 
Postvention: Caring for the team after a suicide
Following any suicide or other traumatic event, GPs can play a critical postvention role for colleagues and teams.
 
Timely support, trauma-informed counselling, and medical workplace (hospital or practice) support can reduce secondary trauma and prevent further harm.
 
Hope and optimism in adversity
The mental health crisis in medicine has been long-standing.
 
Its roots, stigma, fear of mandatory reporting, lack of trauma recognition and unsafe workplaces, are finally being exposed to the light of contemporary government legislated WHS changes to reduce psychosocial risks.
 
The health system is not exempt from these new laws and general practice must be adequately funded to uphold them.
 
Preventive health is the essence of general practice – preventive mental health care must apply equally to ourselves.
 
In a harsh world full of challenges, caring for each other has never been more important.
 
Where to get help

• Your trusted GP or psychologist
• Your employer or college may have a confidential EAP
• Doctors’ Health Alliance – call the Doctors’ Health Line 24/7: 1800 006 888 to be directed to your local doctors’ health service. Doctors’ Health Services are free and available across Australia for doctors and medical students
• Be connected to a counsellor through Drs4Drs: 1300 374 377
• Lifeline: 13 11 14

Resources
www.SafeDr.org is a free resource that puts WHS literacy at every doctor’s fingertips, empowering the medical profession through transformational new WHS law reforms to address unsafe working conditions in healthcare.
 
Hand n Hand Peer Support provides free, confidential and independent peer support for all health professionals, care staff and non-clinical staff.
 
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burnout mental health

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